Sham surgery is something like a placebo surgery: the patient is anesthetized, the surgeon makes some incisions, and then the incisions are sewed up and the patient is restored to consciousness. Because all the evidence suggests the patient really did have a surgery, he or she will believe that the surgery took place. Sham surgery is used in some research trials to test the efficacy of surgical techniques, although the practice is not without controversy.

In several clinical trials, including a study on Alzheimer's patients and a study on patients with knee problems, this procedure actually worked better than the real surgery, in terms of patient response. Over a period of extensive follow-up, patients who had undergone sham surgery indicated they had experienced positive results after the surgery, with significant improvement in body function and quality of life. This raised interesting questions about the role of patient expectations in surgical treatment, and about how this procedure should be used.

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In most clinical trials for things like drugs, the subjects are divided into several groups and given doses of the medication being taken or a totally inert placebo. Typically such studies are “double blind,” meaning the people administering the medication don't know whether the patients are getting the real thing, or a placebo. This measure is designed to reduce the influence of expectations on the outcome as the trial, as expectations clearly have a strong influence on the efficacy of a treatment. When examining the results of a study to see whether or not a drug works, therefore, people look at the response of people in the placebo group as compared to those taking the actual medication.

Sham surgery is offered along similar lines. Patients are informed when they enter the study that they may receive an actual surgery, or a placebo surgery, ensuring the study's architects have what is known as “informed consent,” and then all of the patients are anesthetized to provide the illusion of surgical conditions. When they wake up from the “surgery,” sham surgery patients are given the same care as regular surgical patients, typically from nurses and other support staff who don't know whether the patients received the surgery or a placebo. If the surgical treatment being tested is really effective, patients who received the real surgery will substantially improve, while placebo patients should see no change, despite their belief that they received the surgery.

This practice encounters some thorny ethical issues. Some ethicists are opposed to it, arguing that a sham surgery, unlike a drug placebo, is not actually inert. Surgery carries a number of potential risks, so subjecting people to anesthesia and its associated risks along with the risks of infection seems questionable. However, the success of these procedures in the testing of surgical techniques has suggested that perhaps placebo surgeries do have a place in carefully monitored studies.

Discuss this Article

anon284117Post 8

It seems to me that since placebos act like drugs in the patient's mind, I would venture to say that all drugs are placebos. There are the patient's expectations, and also, the doctor or surgeon's expectations.

The placebo effect is the result of the fact that "disease" and "health" are result of imagination, or some kind of self induced hypnosis. Emotional conflicts bring imbalance in the body, resulting in "disease".

Placebos, having to do with belief, brings an improvement to a so called condition.

anon278042Post 7

Only through controversial practices such as the one described above can research progress to help humans. If we don't take risks, our scientific future will go nowhere.

anon76729Post 5

I agree with the fact that placebos are unethical, and of course deliberately intended to use some for research purposes, and I'm against the game. For example, someone gets to be put in surgery or given something like medicine. At the same time, with the fact that, this placebo game is good because it helps in the research. Ludanga

anon34131Post 4

Is using a placebo drug any different in terms of clinical trials? The people who sign up for them give consent with the full knowledge that some of them will receive the placebo/sham surgery. While the dangers of anesthesia are real, in terms of what's "right" in terms of clinical trials such placebo/sham surgeries are needed in order to show that the -actual- treatment has a real effect.

jabukaPost 3

The placebo, as far as drugs are concerned, is well known, widely used and reported on. However, using placebo surgical techniques to test new surgical procedures has been encouraged lately. This is true particularly in the case of Parkinson's disease, but also knee surgeries.

Some research doctors believe that a placebo surgery is even more important than placebo drugs, while others believe this process is unethical.

This whole concept is complicated and not that easily resolved, however, if placebo surgery proves to help some patients, wouldn't we want to proceed with them? Isn't that the ultimate purpose of medicine, to help the patient?

anon19492Post 2

The use of sham surgery as part of a clinical trial or research programme would not get past any medical research ethics committee in the UK. To compare sham surgery, which is potentially dangerous, with a placebo, which is a harmless inactive substance, is very inaccurate and misleading.

anon19249Post 1

This sounds too too much like a hoax to me...

It would be totally un-ethical to operate on some-one, deceive them, and actually do nothing..for the sake of "clinical trials"...please comment on this.

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